Around 7.4 million fewer type 2 diabetes health checks occurred in UK GP practices between March and December 2020 than before the pandemic, researchers have estimated.
The NICE-recommended checks involve measuring blood pressure and weight, urine tests for protein and blood tests for cholesterol, kidney function and average sugar level.
A study, published in BMJ Quality and Safety last week, analysed the GP records of more than 600,000 people with type 2 diabetes across the UK and compared them to 10-year historical trends to estimate how many health checks were missed last year.
The Manchester-based researchers concluded: ‘In April 2020, in English practices, rates of performing health checks were reduced by 76-88% when compared to 10-year historical trends, with older people from deprived areas experiencing the greatest reductions.
‘Between May and December 2020, the reduced rates recovered gradually but overall remained 28%–47% lower, with similar findings in other UK nations.’
They added: ‘Extrapolated to the UK population, there were ~7.4 million fewer care processes undertaken March–December 2020.’
The study also found that between March and December 2020:
- Around 31,800 fewer people with type 2 diabetes across the UK were given a new kind of diabetes medication;
- And roughly 14,600 fewer people with the condition across the UK were prescribed a new type of blood pressure lowering treatment.
It said this ‘almost certainly’ means many people will have poorly managed diabetes and high blood pressure, leaving them at greater risk of developing serious complications such as ‘heart attacks, strokes, kidney failure and amputations’.
However, it added that ‘lower general practice attendance due to Covid-19 would likely restrict the ability to perform these essential health checks’.
Study lead Dr Matthew Carr, from The University of Manchester, said: ‘Health checks for people with type 2 diabetes are generally carried out in general practice and as face-to-face appointments aren’t yet back up to pre-Covid levels, delays are likely to continue.
‘As a result, there’s an urgent need to reduce the harm caused by these changes to the way care has been delivered.’
But Watford GP Dr Simon Hodes said rising workload and falling GP numbers mean practices can’t cope with demand.
He told Pulse: ‘Workload in general practice is up around 10% from last year and in addition to that we’re now dealing with Covid boosters and a huge seasonal flu campaign with an enlarged cohort again. There are fewer GPs to shoulder the work, increasing demand and expectations.’
Dr Hodes added: ‘There has been a well-recognised “shadow pandemic” of non-Covid conditions that need addressing. Many patients we are seeing are overdue [long-term condition] checks and have stored up various problems during lockdown, making for complex consultations when they do attend.
‘Diabetics usually get a retinal fundoscopy once a year, but [it was] decided at some point during the pandemic that for well-controlled low-risk with good glycaemic control and previous normal fundoscopy it should be safe to stretch out their checks for two years. Sensible changes such as this are reasonable and pragmatic.’
He said that patients should be enabled to ‘self-test’ to reduce the burden on over-stretched practice staff.
He told Pulse: ‘We need to think outside the box to enable patients to self-test – as they do routinely for blood pressure, for example – and this helps patients take control of their [long-term conditions], empowers them and also reduces footfall and use of the NHS, allowing us to focus resources on those most in need.’
It said that almost 4.1 million people in the UK currently have some form of diabetes, and predicted the figure would rise to 5.5 million by the end of the decade.
Meanwhile, NHS figures show that the primary care diabetes drug bill has risen by 62% in 5 years, meaning prescribing for diabetes in primary care now accounts for 12.5% of the total spend on all prescription items in England.
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